ИСПОЛЬЗОВАНИЕ ПЛАЗМЫ, ОБОГАЩЕННОЙ ТРОМБОЦИТАМИ, ПРИ ЛЕЧЕНИИ ОЖОГОВ В ЭКСПЕРИМЕНТЕ

Background. In patients operated for acute paraproctitis, the postoperative period has its own peculiarities. The main of them is that topographiсal anatomy of perineal zone allows performing mechanical necrectomy to the limits of healthy tissues only in part. The purpose of our study was to evaluate the effectiveness of using acerbin and oflocain ointments in one group and levomekol in another group of patients during local treatment of surgical wounds after acute paraproctitis. Materials and methods. For local treatment of perineal wounds in the first phase of the wound process, patients of the main group from the first day after the operation used acerbin in ointment. At the same time, oflocain ointment was used in these patients for local treatment of anal canal. In comparison group, local treatment of purulent wounds of the perineum and anal canal was carried out with levomekol or levosin in ointments. When evaluating the local signs of the course of purulent-destructive process, we have took into account the results of cytological and bacteriological studies. Results. Elimination of microbial contamination of wounds in patients of the main group was more intense than in the comparison group. After 7–10 days of local treatment, complete bacteriological wound healing occurred in 35.7 % of patients in the main group. In the control group, complete bacteriological wound healing occurred only in 17.2 % of patients, which is 2.1 times less than in the main group of patients. The transition of the wound process to the second phase in patients of the main group was observed after 7–9 days, and in the control group it was after 9–11 days. According to our data, patients in the comparison group were staying in the hospital for 19.70 ± 0.43 days, in the main group — 14.8 ± 0.6 days (p < 0.01). Conclusions. Application of acerbin and oflocain in ointments during the local treatment of wounds in patients after surgery for acute paraproctitis substantially accelerated wound healing and improved the results of treatment.

Background: Burns are one of the most common injuries in the world, most importantly during the wars, and the patients usually experience high levels of pain. Complications include both physical and psychological aspects as well as aesthetic concerns. Management comprises special strategies via specific treatment protocols. Treatment stages include: rescue and control of breathing rhythm, hemorrhage management, fracture closure, particle removal, infection control and control of body temperature. It has been suggested that laser therapy with low level energy could have a positive effect on wound healing process. Objectives: The aim of this study was to examine the effect of different wavelengths of Ga-As laser with blue (405 nm) and green (532 nm) wavelengths on the healing of third-degree burn wounds in Wistar rats. Materials and Methods: In this study, 36 male Wistar rats (8-weekold, weighting 250-300 g) were divided into three groups of equal numbers. All animals were anesthetized by intraperitoneal injections. Dorsal hairs were shaved and third-degree skin burns were created on the back of the animals by using a copper stamp. The stamp was warmed up first to 95˚C via a heater. Afterwards, the animals were randomly divided into the blue and green laser and control groups. The length and width of each wound were measured by a caliper and the area of the lesion was calculated on the first, third, seventh, tenth, fourteenth, seventeenth, and twenty-first days of the study. Six samples were taken from each group for pathobiological analysis. Results: A mild anti-inflammatory effect of blue laser was observed during acute phase, which could possibly accelerate wound healing during the first week of repair. Results of our study showed that using low-level laser therapy (LLLT) with green and blue wavelengths may accelerate the wound healing process as compared with the control group. Conclusions: The laser groups have a more rapid rate of wound contraction than the control group during the healing process of burns; however, the effect of LLLT on burn wound healing was neither statistically nor histologically significant. More studies should be performed to investigate other treatment protocols and prescriptions of soft laser to clarify its role in the treatment of wounds and burn injuries.

Adipose-derived stem cells (ADSCs) transplant has been reported to be a potential treatment for burn wounds. However, the effects of autogenicity and allogenicity of ADSCs on burn wound healing have not been investigated and the method for using ADSCs still needs to be established. This study compared the healing effects of autologous and allogenic ADSCs and determined an optimal method of using ADSCs to treat acute burn wounds. Experiments were performed in 20 male Wistar rats (weight, 176–250 g; age, 6–7 weeks). Two identical full-thickness burn wounds (radius, 4 mm) were created in each rat. ADSCs harvested from inguinal area and characterized by their high multipotency were injected into burn wounds in the original donor rats (autologous ADSCs group) or in other rats (allogenic ADSCs group). The injection site was either the wound center or the four corners 0.5 cm from the wound edge. The reduction of burn surface areas in the two experimental groups and in control group were evaluated with Image J software for 15 days post-wounding to determine the wound healing rates. Wound healing was significantly faster in the autologous ADSCs group compared to both the allogenic ADSCs group (p<0.05) and control group (p<0.05). Wound healing in the allogenic ADSC group did not significantly differ from that in control group. Notably, ADSC injections 0.5cm from the wound edge showed significantly improved healing compared to ADSCs injections in the wound center (p<0.05). This study demonstrated the therapeutic efficacy of ADSCs in treating acute burn wounds in rats. However, only autologous ADSCs improved healing in acute burn wounds; allogenic ADSCs did not. This study further determined a superior location of using ADSCs injections to treat burn wounds including the injection site. Future studies will replicate the experiment in a larger and long-term scale burn wounds in higher mammalian models to facilitate ADSCs therapy in burn wound clinical practice.

Objective: To compare the effects of platelet-rich plasma injection with those of dry needling on shoulder pain and function in patients with rotator cuff disease. Design: A single-centre, prospective, randomized, double-blinded, controlled study. Setting: University rehabilitation hospital. Participants: Thirty-nine patients with a supraspinatus tendon lesion (tendinosis or a partial tear less than 1.0 cm, but not a complete tear) who met the inclusion criteria recruited between June 2010 and February 2011. Intervention: Two dry needling procedures in the control group and two platelet-rich plasma injections in the experimental group were applied to the affected shoulder at four-week intervals using ultrasound guidance. Measurements: The Shoulder Pain and Disability Index, passive range of motion of the shoulder, a physician global rating scale at the six-month follow-up, adverse effects monitoring and an ultrasound measurement were used as outcome measures. Results: The clinical effect of the platelet-rich plasma injection was superior to the dry needling from six weeks to six months after initial injection (P < 0.05). At six months the mean Shoulder Pain and Disability Index was 17.7 ± 3.7 in the platelet-rich plasma group versus 29.5 ± 3.8 in the dry needling group (P < 0.05). No severe adverse effects were observed in either group. Conclusions: Autologous platelet-rich plasma injections lead to a progressive reduction in the pain and disability when compared to dry needling. This benefit is certainly still present at six months after treatment. These findings suggest that treatment with platelet-rich plasma injections is safe and useful for rotator cuff disease.

The treatment of purulent wounds in patients with diabetes mellitus is a difficult and urgent problem of the modern medicine. The disruption of the immune status is one of the pathogenetic links of the cascade of pathological processes with purulent wounds in patients with diabetes mellitus. The aim of the study is to revealing the features of the morphological and functional reorganization of the thymus in various methods of the treatment of purulent wounds against the background of alloxan diabetes under experimental conditions. The therapeutic efficacy of the drug miliacylum and EHF-therapy was studied in 128 white outbred albino rats to whom simulated the wound process of the hind limbs against the background of alloxan diabetes. In 32 rats of the main group, miliacylum and EHF-therapy were used in the local treatment of wounds. In 32 animals of the first control group, wounds were not treated. Wounds in 32 rats of the second control group were treated with miliacylum. In 32 animals of the third control group, EHF-therapy was used in the treatment of wounds. We were conducted histological and immune-cytochemical studies of the thymus in animals of all groups on the 7th, 14th, 21st and 28th day of treatment. The terms of the healing of purulent wounds in animals against the background of alloxan diabetes, in the main group were 11.91 ± 0.28 days, which is statistically significantly shorter than the terms in animals that were treated only with miliacylum (13.88 ± 0.26 days), and in animals who were not treated or used only EHF-therapy (more than 28 days). In the analysis of a series of histological preparations of the thymus, an atrophy of the thymus parenchyma (of the cortex and of the medullary substance) was found, in combination with hyperplasia of the interlobar perivascular spaces with a simultaneous increase in the proportion of adipose tissue. However, the phenomenon of accidental involution was less pronounced in animals of the main group than in rats of the control groups. Treatment of purulent wounds with miliacylum and EHF-therapy provides not only optimization of reparative processes in the wound area, but also limits the involution of the thymus gland and, thus, prevents disturbances in the central organ of immunogenesis.

ObjectivesIn this study, we aimed to investigate the effectiveness of intra-articular platelet-rich plasma (PRP) injection in adhesive capsulitis.Patients and methodsBetween January 2019 and December 2019, a total of 40 patients (21 males, 19 females; mean age: 57.1±6.5 years; range, 44 to 72 years) with idiopathic adhesive capsulitis were included. The patients were randomly assigned into two equal groups as the PRP and the control group. The PRP group received two doses of PRP via intra-articular route biweekly under ultrasound guidance. No injection was performed to the control group. In both groups, stretching and Codman exercises were applied as a home- based program. The Visual Analog Scale (VAS), range of motion (ROM), and Shoulder Pain and Disability Index (SPADI) scores were evaluated before the treatment and at 2, 6 and 12 weeks after the treatment.ResultsThere were significant differences in all VAS, SPADI, and ROM scores at all time points after treatment compared to baseline in both groups. At the end of the study, there were significant differences in the active flexion, passive flexion, active abduction, passive abduction, and active external rotation scores at 12 weeks between the groups (p=0.012, p=0.015, p=0.008, p=0.019, and p=0.040, respectively). No significant difference was observed between the groups in terms of VAS and SPADI scores and the other parameters (active and passive extension, active and passive internal rotation, passive external rotation) at 2, 6, and 12 weeks (p>0.05).ConclusionThe addition of PRP to exercise treatment can improve patients' joint mobility, but not pain and disability in patients with adhesive capsulitis.

Background: To investigate the effectiveness of platelet-rich plasma (PRP) injection among patients with rotator cuff tendinopathy in comparison with sham injection, no injection, or physiotherapy alone. Methods: From the earliest records to November 1, 2018, all published or unpublished randomized controlled trial (RCTs) comparing PRP injection with a control group (sham injection, no injection, or physiotherapy alone) in patients with rotator cuff tendinopathy were included. Eligible trials were included from the search results of electronic databases including PubMed, EMBASE, Scopus, The Cochrane Library, as well as the bibliographies of relevant trials. Five RCTs were enrolled in our meta-analysis. Two authors independently assessed the quality of RCTs with the Cochrane risk of bias tool. We designated pain reduction as the primary outcome and functional improvement as the secondary outcome. Standardized mean difference (SMD) was applied for random-effect meta-analysis. Results: In the short term (3–6 weeks) and medium term (12 weeks), the effectiveness of PRP injection and control group was indistinguishable in terms of both outcomes (pain reduction and functional improvement). Nevertheless, PRP injection led to significant long-term (>24 weeks) pain relief (SMD: 0.42, 95% confidence interval (CI): 0.12–0.72, without heterogeneity). For functional improvement in the long term, PRP injection was not more effective than the control group (SMD: 1.20, 95% CI: −0.20–2.59, with heterogeneity). Conclusions: PRP injection may provide benefit over the control group (sham injection, no injection, or physiotherapy alone) in reducing pain at long-term follow-up for patients with rotator cuff tendinopathy.

To study the effect of platelet-rich plasma (PRP) injections on pain reduction in patients with temporomandibular joint osteoarthritis (TMJ OA). The authors performed a comprehensive search of the MEDLINE, PubMed, and Web of Science databases to retrieve RCTs published up to July 2018. Pain outcomes (visual analog scale scores) were extracted to assess the effect of PRP injections on TMJ OA. All data analyses were conducted using RevMan 5.3. Six studies were included. According to the results of these trials, intra-articular injections of PRP were more effective than placebo for pain reduction (6 months postinjection: mean difference [MD] -2.82, 95% CI -3.39 to -2.25, P < .00001; 12 months postinjection: MD -3.29; 95% CI -4.07 to -2.52, P < .00001). Additionally, the comparison between PRP and hyaluronic acid injections showed a statistically significant difference in pain reduction in support of PRP (MD -0.81; 95% CI -1.22 to -0.40; P = .0001) at 12 months postinjection. All trials revealed a moderate risk of bias. Based on current evidence, PRP injections may reduce pain more effectively than placebo injections in TMJ OA at 6 months (level of evidence: moderate) and 12 months (level of evidence: moderate) postinjection. This significant difference in pain reduction could also be seen when PRP was compared to hyaluronic acid at 12 months postinjection (level of evidence: low). It can be cautiously interpreted that PRP has a beneficial effect on the relief of TMJ OA pain. Large-scale, low-bias RCTs are needed to test whether PRP injection should be a routine treatment for patients with TMJ OA.

To investigate the effect of allogeneic nanofat combined with platelet-rich plasma (PRP) for treatment of pressure injury wounds in rats. Forty SD rat models with pressure injury wounds were randomly divided into 4 groups (n=10) for treatment with nanofat, PRP (platelet count about 6.2 times that of normal whole blood), nanofat combined with PRP, or PBS only (control group).Wound healing was observed on days 1, 3, 5, 7, 10 and 14 and wound healing rate was calculated. On days 5, 10 and 14, tissue samples were taken from the wounds for HE staining, Masson staining, immunohistochemistry, and Western blotting to observe inflammatory cell infiltration, collagen formation, deposition and arrangement, angiogenesis, inflammatory factor expression and VEGF expression in the wounds. The combined treatment with nanofat and PRP achieved the highest wound healing rates at all the time points of observation (P < 0.05), enhanced inflammatory cell infiltration on day 5, and accelerated dermal and epidermal growth compared with the other treatments (P < 0.05). The combined treatment also more effectively promoted collagen expression and its regular arrangement (P < 0.05) and enhanced angiogenesis in the wounds than nanofat and PRP alone, without significant difference between the latter two treatments (P > 0.05). Immunohistochemistry and Western blotting showed that the expressions of MCP-1 and VEGF in the wounds were the highest in the combined treatment group (P < 0.05) and were higher in nanofat and PRP treatment groups than in the control group (P < 0.05). Nanofat combined with PRP can significantly promote healing of pressure injury wounds in rats, and their synergistic effect sheds light on a new strategy for treatment of pressure injury wounds.

Synergistic effect of platelet-rich plasma injections and scalp lifting in androgenetic alopecia

The effectiveness of Platelet-Rich Plasma (PRP) in the treatment of patients with Achilles tendon rupture (ATR) and Achilles tendinopathy (AT) has been controversial. To assess PRP injections' effectiveness in treating ATR and AT. A comprehensive review of relevant literature was conducted utilizing multiple databases such as Cochrane Library, PubMed, Web of Science, Chinese Science and Technology Journal, EMBASE, and China Biomedical CD-ROM. The present investigation integrated randomized controlled trials that assessed the effectiveness of platelet-rich plasma injections in managing individuals with Achilles tendon rupture and tendinopathy. The eligibility criteria for the trials encompassed publications that were published within the timeframe of January 1, 1966 to December 2022. The statistical analysis was performed utilizing the Review Manager 5.4.1, the visual analogue scale (VAS), Victorian Institute Ankle Function Scale (VISA-A), and Achilles Tendon Thickness were used to assess outcomes. This meta-analysis included 13 randomized controlled trials, 8 of which were randomized controlled trials of PRP for AT and 5 of which were randomized controlled trials of PRP for ATR. PRP for AT at 6 wk [weighted mean difference (WMD) = 1.92, 95%CI: -0.54 to 4.38, I2 = 34%], at 3 mo [WMD = 0.20, 95%CI: -2.65 to 3.05, I2 = 60%], and 6 mo [WMD = 2.75, 95%CI: -2.76 to 8.26, I2 = 87%) after which there was no significant difference in VISA-A scores between the PRP and control groups. There was no significant difference in VAS scores between the PRP group and the control group after 6 wk [WMD = 6.75, 95%CI: -6.12 to 19.62, I2 = 69%] and 6 mo [WMD = 10.46, 95%CI: -2.44 to 23.37, I2 = 69%] of treatment, and at mid-treatment at 3 mo [WMD = 11.30, 95%CI: 7.33 to 15.27, I2 = 0%] after mid-treatment, the PRP group demonstrated better outcomes than the control group. Post-treatment patient satisfaction [WMD = 1.07, 95%CI: 0.84 to 1.35, I2 = 0%], Achilles tendon thickness [WMD = 0.34, 95%CI: -0.04 to 0.71, I2 = 61%] and return to sport [WMD = 1.11, 95%CI: 0.87 to 1.42, I2 = 0%] were not significantly different between the PRP and control groups. The study did not find any statistically significant distinction between the groups that received PRP treatment and those that did not, regarding the Victorian Institute of Sport Assessment - Achilles scores at 3 mo [WMD = -1.49, 95%CI: -5.24 to 2.25, I2 = 0%], 6 mo [WMD = -0.24, 95%CI: -3.80 to 3.32, I2 = 0%], and 12 mo [WMD = -2.02, 95%CI: -5.34 to 1.29, I2 = 87%] for ATR patients. Additionally, no significant difference was observed between the PRP and the control groups in improving Heel lift height respectively at 6 mo [WMD = -3.96, 95%CI: -8.61 to 0.69, I2 = 0%] and 12 mo [WMD = -1.66, 95%CI: -11.15 to 7.83, I2 = 0%] for ATR patients. There was no significant difference in calf circumference between the PRP group and the control group after 6 mo [WMD = 1.01, 95%CI: -0.78 to 2.80, I2 = 54%] and 12 mo [WMD = -0.55, 95%CI: -2.2 to 1.09, I2 = 0%] of treatment. There was no significant difference in ankle mobility between the PRP and control groups at 6 mo of treatment [WMD = -0.38, 95%CI: -2.34 to 1.58, I2 = 82%] and after 12 mo of treatment [WMD = -0.98, 95%CI: -1.41 to -0.56, I2 = 10%] there was a significant improvement in ankle mobility between the PRP and control groups. There was no significant difference in the rate of return to exercise after treatment [WMD = 1.20, 95%CI: 0.77 to 1.87, I2 = 0%] and the rate of adverse events [WMD = 0.85, 95%CI: 0.50 to 1.45, I2 = 0%] between the PRP group and the control group. The use of PRP for AT improved the patient's immediate VAS scores but not VISA-A scores, changes in Achilles tendon thickness, patient satisfaction, or return to sport. Treatment of ATR with PRP injections alone improved long-term ankle mobility but had no significant effect on VISA-A scores, single heel lift height, calf circumference or return to sport. Additional research employing more extensive sampling sizes, more strict experimental methods, and standard methodologies may be necessary to yield more dependable and precise findings.

A high risk of complications in burn injuries is associated with the development of systemic inflammatory response syndrome. Thermal injury (burn) causes the release of cytokines and prostaglandia, resulting in increased interaction between leukocytes, platelets and endothelial cells. Activation of leukocytes leads to an increase in the formation of reactive oxygen species (ROS) and nitrogen, which is normally compensated by the activation of protective antioxidant enzymes. An imbalance between the activity of the radical-producing and antioxidant systems leads to an excess of free radicals and the development of oxidative stress. Oxidative stress limits the repair of damaged tissue and also leads to localized chronic inflammation. Thus, the removal of inflammation and a decrease in the ROS level, which exceeds the physiological level in the burn zone, seems to be expedient for accelerating the healing process of burn injuries of the skin. In this study, we used a polysaccharide hydrogel modified with cerium dioxide (CeO2) nanoparticles, which have unique anti-inflammatory and antioxidant properties, as an effective agent for the treatment of thermal burns. It has been shown that modification of the hydrogel with CeO2 nanoparticles provides accelerated healing of a model burn wound in rats. Already on the 5th day after the treatment of damage to the skin with the modified hydrogel, a decrease in the area of ​​the burn wound that is different from the control is observed. The use of a hydrogel accelerates the healing process of a burn wound on the 25th day by 25.42% (p &lt;0.05) and ensures complete healing of burn wounds on average 5 days earlier in comparison with the control group with Levomekol ointment. Treatment of burn wounds using a hydrogel leads to the formation of a small post-burn scar. Thus, a polysaccharide hydrogel modified with CeO2 nanoparticles can be considered as an effective wound healing agent in the treatment of thermal burns and skin lesions of various etiologies.

Platelet-rich plasma injections are used as a treatment for chronic midportion Achilles tendinopathy, but evidence for this treatment is limited. In adults with midportion Achilles tendinopathy, to assess the effects of a single platelet-rich plasma injection, compared with sham injection, on the outcome of the Victorian Institute of Sport Assessment-Achilles (VISA-A) score (a single composite measure of Achilles tendinopathy severity). A participant-blinded, multicenter randomized clinical trial that included 240 people from 24 sites assigned to either a platelet-rich plasma injection or a sham injection between April 2016 and February 2020. Final follow-up was July 2020. Participants were older than 18 years with midportion Achilles tendon pain for more than 3 months as confirmed by ultrasound, magnetic resonance imaging, or both. A single intratendinous platelet-rich plasma injection (n = 121) or a single sham injection (insertion of a subcutaneous dry needle not entering the tendon) (n = 119). The primary outcome was the VISA-A score, measured 6 months after treatment allocation. The VISA-A score contains 8 questions that cover 3 domains of pain, function, and activity, analyzed as a composite score (range, 0 [worst symptoms] to 100 [no symptoms]; minimal clinically important difference in score, 12 points). The primary analysis was adjusted for laterality, age, sex, and baseline VISA-A score. Among 240 patients assigned to a platelet-rich plasma or sham injection (mean age, 52 years; 138 [58%] women), 221 (92%) completed the trial. At 6-month follow-up, mean VISA-A score values in the plasma-rich plasma group vs the sham injection group were 54.4 vs 53.4 (adjusted mean difference, -2.7 [95% CI, -8.8 to 3.3]). The most common adverse events compared between patients in the platelet-rich plasma group vs the sham group were injection site discomfort (97 vs 73 patients), swelling (56 vs 52 patients) and bruising (48 vs 49 patients). Among patients with chronic midportion Achilles tendinopathy, treatment with a single injection of intratendinous platelet-rich plasma, compared with insertion of a subcutaneous dry needle, did not reduce Achilles tendon dysfunction at 6 months. These findings do not support the use of this treatment for chronic midportion Achilles tendinopathy. isrctn.org Identifier: ISRCTN13254422.

Wound Literature Review 2010

This study aimed to evaluate the effect of 10% topical sucralfate on healing radiofrequency-induced burn wounds in rats. Twenty (20) male rats were divided into 2 equal groups. Using radiofrequency, 4 full-thickness, 1 cm in diameter round burns were created on the backs of the rats that then were randomized to receive twice-daily treatment for 30 days with 10% sucralfate or neutral cream. Biopsies were taken on days 4, 7, 14, and 21 to analyze fibrin-leukocyte crut, edema density, epidermal-dermal cell infiltration, amount of fibroblast and collagen fibers, amount of elastic fibers, neovascularization-angiogenesis, and reepithelialization-granulation tissue. Data were collected to a spreadsheet and entered into statistical software for analysis. Histopathological features were classified as categorical variables and compared using the χ2 test and Fisher's exact test. When χ2 was used, Yates' correction for continuity was performed. All reported P values were 2-tailed; P less than .05 was considered statistically significant. On day 4, improvement in edema density (P = .034), epidermal detachment (P = .020), epidermal-dermal cell infiltration (P = .007), and polymorphonuclear leukocyte infiltration (P = .021) were statistically more significant in the sucralfate than control group. On day 7, epidermal-dermal cell infiltration (P = .007) and elastic fibers P = .050) were statistically more significant in the sucralfate group. On day 14, angiogenesis (P = .029), reepithelialization (P = .035), and granulation tissue (P = .003) were statistically more significant in the sucralfate group. By the end of the study (day 30), angiogenesis (P = .010), reepithelialization (P <.001), fibroblast density (P = .016), granulation tissue (P = .035), and collagen density (P = .002) were significantly improved in the sucralfate group versus the control group. In a rat wound model, 10% topical sucralfate was found to histopathologically facilitate the healing process compared to the control group. Controlled clinical studies are needed to elucidate the effect of this treatment in human wounds.